Bosses Spawned by It Lives will be spawned in order the first time, with Monstro being first, followed by Larry Jr., the Duke of Flies and finally Chub.

*Any normal enemy may randomly be replaced by one of its counterparts, including kamikaze leeches, holy leeches, bloodshot eyes, spits and selfless knight variants respectively.

Killing him for the first time unlocks the character "???", and the floor Sheol, otherwise accessed from the Devil Room. Accessing the Sheol devil room requires meeting the same criteria that spawns regular devil rooms.

Strategy for defeating It Lives is generally the same as defeating Mom's Heart, though it is advised to focus on dealing damage to It Lives whenever possible as avoiding a single boss such as Chub while fighting It Lives tends to be simpler than keeping up with the constant inflow of enemies and bosses.

Notes

Just as with Mom and Mom's Heart, It Lives can be instantly killed by using The Bible item.

Defeating this boss in future runs will no longer produce the golden chest for completing this game, instead requiring you to complete either of the following "final" floors to win instead.